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Purpose: To report a very rare and atypical case of an elderly Caucasian female patient who developed perilesional multiple polypoidal choroidal vasculopathy (PCV) as a probable complication of choroidal osteoma (CO), associated to preretinal neovascular membrane overlying the lesion., Methods: Observational case report., Case Observation: A 60-year-old Caucasian woman presented with blurred vision in her right eye (RE). Fundus examination revealed a round white-yellowish calcified deep lesion in the juxta-papillary superior area, measuring 4 disc-diameters, with well-defined scalloped margins and an irregular surface. B-scan ultrasonography and orbital tomography confirmed the diagnosis of choroidal osteoma (CO). Further investigation with multimodal imaging including infracyanine green angiography, fluorescein angiography, swept source optical coherence tomography and angiography highlighted the presence of multiple aneurysmal choroidal dilations around the CO, corresponding to PCV. We also noted the presence of a preretinal neovascular membrane overlying the CO. The patient was monitored with regular follow-up since no signs of activity were detected on multimodal imaging., Conclusion: Our case report represents an exceptional and atypical association between pre-retinal neovascularization, PCV and choroidal osteoma. While the mechanisms underlying the development of PCV and pre-retinal neovascularization in the setting of CO are not well understood, it is imperative for ophthalmologists to recognize this association as a potential cause of sudden vision loss in patients with CO, and to consider appropriate diagnostic and management strategies., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

To present the efficacy of autologous neurosensory retinal transplantation in macular holes surgery with rhegmatogenous retinal detachment. Eleven eyes of 11 patients with rhegmatogenous retinal detachment associated to a large macular hole were enrolled between January 2019 and January 2021 in the Department A of the Hedi Rais Institute of Ophthalmology (Tunis, Tunisia). All patients underwent a 23 G pars plana vitrectomy. An autologous neurosensory retinal patch was placed inside the macular hole. Long-acting silicone tamponade was carried out. Clinical features of the macular area, best-corrected visual acuity (BCVA), fundus examination, and SD-OCT were recorded before surgery, at 1- and 3-month follow-up after surgery. The mean age of our population was 56.6 ± 10.33 years old, ranged from 45 to 76 years old. Final retinal reattachment was achieved clinically in all eyes. The Spectral domain-Optical Coherence Tomography (SD-OCT) follow-up showed the macular hole closure. The retinal patch was demonstrated by OCT at each control. BCVA improved from 1.52 ± 0.23 Logarithm of the Minimum Angle of Resolution (LogMAR) to 0.89 ± 0.16 LogMAR 3 months after surgery ( p = 0.014). No adverse events were registered during the study. Autologous neurosensory retinal transplantation has been efficient to treat macular hole associated to rhegmatogenous retinal detachment. Further multicentric studies with a large number of patients are needed to establish the results of this technique in complex cases.

Purpose: The goal of our study is to describe the functional results and preoperative factors predicting visual recovery after successful inverted flap technique and closure of large full-thickness macular holes (FTMH) and to evaluate the correlations between microstructural foveal changes and final visual acuity., Methods: Retrospective, descriptive, analytical study including 80 eyes of 78 patients with large FTMH; operated by inverted flap technique with successful closure of the macular hole after surgery. All eyes underwent a full preoperative ophthalmic examination and macular B-scan SD-OCT. We performed the classic inverted flap technique for all patients. Postoperatively, all patients were examined at 7 days, 1, 3, 6, 9 and 12 months after surgery. SD-OCT was performed for all patients on each follow-up. Preoperatively, best-corrected visual acuity (BCVA), FTMH size and basal hole diameter were the main outcome measures. Postoperatively, BCVA, macular thickness, integrity of the external limiting membrane (ELM) and ellipsoid zone (EZ) were recorded., Results: Mean age was 62±8.42 years with female predominance. Mean size of the FTMH was 692.59μm, and mean basal hole diameter was 1436.06μm. Mean BCVA improved from 1.06±0.491 LogMAR preoperatively to 0.52±0.32 at 9 months following surgery (P<0.001). At 9 months, the ELM was absent, partial or fully restored in 6.67, 10 and 83.33% respectively. The EZ was absent, partial or fully restored in 6.67, 33 and 63.33% respectively. ELM regeneration always preceded EZ regeneration at every point of follow-up. Final BCVA was statistically correlated with initial hole size (P=0.006, OR=1.056; CI [1.016-1.098]) and mean symptom duration prior to surgery (P=0.001. OR=0.987; CI [0.976-0.998]). Analysis of the ROC curve demonstrated that a hole diameter>478.5μm and symptom duration>5 weeks were correlated with non-improvement of visual acuity, with 81.3% sensibility and 18.7% specificity., Conclusion: We report tomographic microstructural foveal changes and functional results following successful large idiopathic FTMH surgery using the classic inverted flap technique. Preoperative parameters such as initial FTMH diameter and mean symptom duration prior to surgery are crucial prognostic factors influencing final visual results., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Prcis: Primary congenital glaucoma (PCG) in Tunisian children seems to be characterized by a high prevalence of inherited and advanced forms of the disease. Primary combined trabeculotomy trabeculectomy (CTT) allowed satisfactory long-term intraocular pressure (IOP) control and reasonable visual outcome., Purpose: To report the long-term outcome of CTT as the initial glaucoma surgery in children with PCG., Methods: Retrospective analysis of children who underwent primary CTT for PCG between January 2010 and December 2019. The main outcome measures were IOP reduction, corneal clarity, complications, refractive errors, and visual acuity (VA). Success was defined as IOP <16 mm Hg without (complete) or with (qualified) antiglaucoma medication. The WHO criteria of vision loss were used to categorize visual impairment (VI)., Results: Of 62 patients, 98 eyes were enrolled. At the last follow-up, the mean IOP was reduced from 22.7 ± 4.0 mm Hg to 9.7 ± 3.9 mm Hg ( P < 0.0001). The complete success rate was 91.6%, 88.4%, 84.7%, 71.6%, 59.7%, and 54.3%, at the first, second, fourth, sixth, eighth, and tenth year, respectively. Follow-up averaged 42.1 ± 28.4 months. Preoperatively, 72 eyes (73.5%) had significant corneal edema versus 11 eyes (11.2%) at the end of the follow-up ( P < 0.0001). Endophthalmitis was encountered in one eye. Myopia was the most common refractive error (80.6%). Data on Snellen VA were available for 53.2% of the patients; 33.3% achieved a VA ≥6/12, 21.2% had mild VI, 9.1% had moderate VI, 21.2% had severe VI, and 15.2% were blind. The failure rate was statistically correlated to the early disease onset (<3 mo) and to preoperative corneal edema ( P = 0.022 and P = 0.037, respectively)., Conclusion: Primary CTT seems to be a good procedure in a population with advanced PCG at presentation, problematic follow-up visits, and limited resources., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: To estimate metamorphopsia prevalence, predictors and etiologies in patients operated for rhegmatogenous retinal detachment (RRD) with detached macula with successful results., Methods: Retrospective study including 50 eyes of 50 patients who underwent pars plana vitrectomy for RRD with detached macula with standard silicone oil (SO) tamponade. Patients who had successful surgery with durable anatomic reapplication of the retina after SO removal were included. Patients were examined on day 1, day 7,1 month, and 3 months after surgery. Best corrected visual acuity, Amsler grid, fundus biomicroscopy, Spectral Domain Optical Coherence Tomography (SD-OCT) and fundus auto-fluorescence (FAF) were performed in all patients after surgery. Structural abnormalities such as macular folds, macular epiretinal membrane, cystoid macular edema, and foveal disruption of the ellipsoid layer were observed on SD-OCT. Macular displacement was identified on FAF., Results: We identified metamorphopsia as post-operative visual impairment in 27 patients among 50 (54%). Clinical assessment found that a delay > 7 days between symptoms and surgery (p < 0.001), more than 2 detached quadrants (p=0.012), and stage C of proliferative vitreoretinopathy (p=0.035) were associated to metamorphopsia. Regarding multimodal imaging findings, only macular folds and macular displacement were significantly correlated with the occurrence of postoperative metamorphopsia (p <0.001)., Conclusion: Metamorphopsia is a common complaint after vitrectomy for RRD. Macular rotation and folds would be the main causes after complete and durable reapplication of the retina.

Purpose: To assess the efficacy and safety of a single preoperative intralesional bevacizumab injection as an adjuvant treatment before primary pterygium surgery., Methods: We conducted a randomized controlled interventional study from January 2019 to December 2020. The study included a total of 60 patients (60 eyes) with primary pterygium. We defined two groups of 30 patients each. Group A received an intralesional injection of bevacizumab (Avastin), 1 month before surgery (lesion excision and conjunctival autograft). Group B (control) had only the surgical treatment. Patients were followed up 7 days (D7), 1 month (M1), 3 months (M3), and 6 months (M6) postoperatively. Pre-, per-, and postoperatively, photographs of the lesions were taken, as well as a histopathological examination. The main outcome measures were the change in functional discomfort following intralesional bevacizumab injection and pterygium recurrence. Recurrence was defined as fibrovascular tissue growth invading the cornea. Therapeutic success was defined as the absence of pterygium recurrence in M6., Results: The mean age of the 60 patients was 54.17 ± 10.53. After bevacizumab injection, the preoperative functional discomfort score decreased significantly ( P = 0.048). There was a significant improvement in grade and color intensity ( P = 0.001). We noted no local nor systemic complications after intralesional injection of bevacizumab. After pterygium excision, the success rate was statistically higher in Group A ( P = 0.047). There was no significant difference in either final best-corrected spectral visual acuity or astigmatism between the two groups. We noted a statistically significant association between recurrence and color intensity ( P = 0.046), vascular density ( P = 0.049), and the degree of elastic tissue degeneration ( P = 0.040)., Conclusion: A single preoperative subconjunctival injection of bevacizumab 1 month before surgery decreases the vascularity of newly formed blood vessels and hence may reduce the recurrence rate., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Current Ophthalmology.)

Purpose: To describe ocular manifestations of acute leukemia in a Tunisian cohort and to assess the associations between ophthalmic findings and epidemiological, clinical, and biological features of the disease., Methods: A prospective study included patients newly diagnosed with acute leukemia referred to our clinics between January 2019 and July 2020. All patients underwent a complete ophthalmic evaluation and spectral-domain optical coherence tomography (SD-OCT) at presentation, then every two months during one year. We defined two groups: Group 1 included patients with leukemic ophthalmopathy and group 2 included patients with normal ophthalmic examination., Results: Forty-six patients were enrolled. The mean age of patients was 32.1±15.3 years. The sex ratio M/F was 1.55 (28 male patients and 18 females). Twenty-nine patients (63%) had acute myeloid leukemia (AML), and 17 (37%) had acute lymphoblastic leukemia (ALL). The average follow-up was 9.1 months (range: 3-12 months). We observed ophthalmic manifestations in 28 patients (61%). Among them, 17 (61%) had vision-threatening complications. The posterior segment was the most common site of ocular involvement (82% of group1). Primary leukemic infiltration (Disc edema, ptosis, exophthalmos) was present in 13 eyes (14.1%). Twenty-seven eyes (29.3%) had secondary involvement lesions (Subconjunctival hemorrhage, periorbital ecchymosis, retinal/sub-hyaloid hemorrhage, dilated/tortuous veins). Twenty-one eyes (22.8%) showed other ocular manifestations which etiopathogenesis is not yet fully understood (White-centred hemorrhages, cotton-wool spots, serous retinal detachment, hemorrhagic pigment epithelial detachment). Leukemic retinopathy was significantly more frequent in adults (23/39 and 1/7 in adult and pediatric groups, respectively; p=0.003). Patients suffering from AML were more likely to have secondary ocular involvement (20/29 and 7/17 in AML and ALL patients, respectively; p=0.047). Retinal hemorrhages were statistically associated with anemia and thrombocytopenia (p=0.041 and p=0.034; respectively)., Conclusion: Leukemic ophthalmopathy seems to be frequent and may lead to severe visual impairment. An ophthalmic assessment complemented with SD-OCT has paramount importance in all newly diagnosed acute leukemic patients., Competing Interests: Dr Hend Benneji reports personal fees from abbvie, outside the submitted work. The authors report no other conflicts of interest in this work., (© 2022 Sayadi et al.)

Orbital cellulitis is a rare disease. Two anatomo-clinical forms can be distinguished: a preseptal "benign" form and a retroseptal "severe" form. The purpose of this study was to analyze the epidemiological, clinical, therapeutic and prognostic profile of orbital cellulitis in a third-line Hospital in Tunis, Tunisia. We conducted a retrospective study involving 109 patients hospitalized for orbital cellulitis. Two groups were distinguished: the retroseptal cellulitis group including 42 patients (38.5%) and the preseptal cellulitis group including 67 patients (61.5%). The average age of patients was 27.1 ± 34.8 years. The sex ratio M/F was 0.84 (45.9% of male patients). Acute sinusitis was the most frequently identified portal for retroseptal cellulitis entry (35.7%, n=15), while acute dacryocystitis was the most common cause of preseptal cellulitis (23.9%, n=16). Diabetes, non-functioning eye and prior use of non-steroidal anti-inflammatory drugs were associated with retroseptal cellulitis (p=0.007, p=0.022 and p=0.014 respectively). All patients received systemic antibiotic therapy. Ten patients (23.8%) of the retro-septal cellulitis group and 5 patients (7.46%) of the preseptal cellulitis group underwent surgery. Nine cases of blindness (8.2%), a case of septic shock and a case of death were reported. Poor prognostic factors were a time of consultation > 7 days (aOR = 4.277, 95% CI = 2.504-32.426, p = 0.006) and Chandler stage>III (aOR = 7.009, 95% CI = 1.69-51.839, p = 0.029). In developing countries and especially in Tunisia, orbital cellulitis can be sight threatening or even life-threatening. Early management could lead to a favorable outcome without sequelae., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts., (Copyright: Manel Mekni et al.)

Background: Calcium-pyrophosphate-dihydrate-disease (CPPD) is a crystal-induced arthropathy. The lumbar-spinal involvement is rare and often under-diagnosed. This study aimed to report the case of a lumbar spine CPPD involvement and to perform a systematic review of clinical, imaging features of lumbar involvement in CPPD patients, and treatments that have been implemented., Methods: This systematic review was conducted in accordance with the Preferred-Reporting-Items-for-Systematic-Reviews and Meta-Analyses (PRISMA) guidelines., Results: One hundred and sixty-seven articles met the search criteria using electronic databases searches. We retained 28 articles (20 case reports, 2 case series, 1 family survey, 4 retrospective studies, and 1 prospective study) involving a total of 62 patients. The age ranged between 39 and 89 years old. Among patients with lumbar spine CPPD, 32 were women. The duration of symptoms varied between one day and 8 years. The affection has been discovered during back pain in most cases. In 5 studies, the diagnosis was made on histological specimens of patients operated on for another pathology. X-ray showed calcifications in 2 cases. CT-scan detected calcium deposit in 7 cases. MRI showed lesions going from the increased signal of the disk, to calcified or not-cystic lesion of the facet joints, an intramedullary mass mimicking a schwannoma. Histological examination established the diagnosis of CPPD in 21 patients in all studies. Medical treatment included NSAIDs, Colchicine, Interleukin-1-receptor-antagonist, and antibiotics. Surgery was performed on 13 patients and allowed to establish the histological diagnosis., Conclusion: In the case of inflammatory back pain in elderly subjects, without an infectious gateway, diagnosis of CPPD should be considered, especially for patients with a history of spinal surgery or degenerative radiography changes. CT scan is more sensitive than conventional radiographs. The discovertebral biopsy is the Gold-Standard and should be performed whenever the diagnosis was uncertain. Treatment includes the medical and surgical components., Competing Interests: The authors report no conflict of interest in this work., (© 2022 Ben Tekaya et al.)

Purpose: To describe the clinical features of congenital cataract (CC) in a Tunisian cohort and to assess the surgical outcomes of primary intraocular lens implantation in two groups based on the age at surgery., Methods: This study was a prospective analysis of children under 5 years with CC that were operated between January 2015 and 2020. The surgery consisted of phacoaspiration with posterior capsulorhexis and primary implantation. Group 1 comprised children operated at <2 years of age and Group 2 comprised children operated between 2 and 5 years. Peri and postoperative surgical events as well as refractive and visual outcomes were compared between both the groups., Results: Fifty-five (84 eyes) infants were enrolled. Group 1 included 30 (48 eyes) children and Group 2 included 25 (36 eyes) patients. The mean follow-up was 27.60 ± 19.89 months. The mean delay between the diagnosis and the cataract surgery was 11.97 ± 13.84 months. Of 14 (16.7%) eyes with postoperative visual axis opacification (VAO), 9 (10.7%) eyes required pars plana membranectomy. The VAO was not statistically associated with the age at surgery ( P = 0.112), but significantly correlated with sulcus implantation ( P = 0.037). The final mean visual acuity was 0.51 logMAR and comparable between both the groups ( P = 0.871). Poor visual outcome was significantly associated with low age at presentation (<6 months; P = 0.039), delay between the diagnosis and time of surgery ( P = 0.001), preoperative nystagmus ( P = 0.02), and poor parental compliance to amblyopia treatment ( P = 0.009)., Conclusions: Primary implantation seems to be safe and efficient. VAO appears to become an avoidable occurrence owing to better surgical techniques. Amblyopia remains the biggest barrier to final visual outcome., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Current Ophthalmology.)

lntralenticular abscess is a very rare entity that has been described after penetrating trauma, intraocular surgery and metastatic spread. We report a case of intralenticular abscess treated surgically by phacoemulsification with good postoperative results. A 32-year-old patient presented with right eye redness and defective vision of 4 days following thorn injury. The visual acuity was limited to counting fingers. Anterior segment examination revealed healed lamellar corneal tear, 3+ cells in the anterior chamber, iris synechia and heterogeneous opacity of the crystalline lens. Vitreous and fundus were normal. Initially, we prescribed topic and systemic antimicrobial treatment. Lens extraction was performed 1 week later by phacoemulsification with primary intraocular lens implantation. The immediate postoperative recovery was uneventful. The visual acuity at last follow-up was 9/10. In the current case, lens extraction associated with systemic and local antimicrobial treatment allowed infection control and good visual outcome., (Copyright: Jihene Sayadi et al.)

Introduction: and importance: Congenital upper eyelid eversion (CUEE) is a rare congenital condition characterized by everted upper eyelids with prominent chemosis. The authors present the first case of concurrent upper eyelids eversion, umbilical hernia, and clubfeet., Case Presentation: A four-hour-old newborn male presented with bilateral red upper eyelids swelling. Ophthalmic examination revealed bilateral upper eyelids eversion and severe bilateral chemosis. The further pediatric evaluation showed a painless reducible umbilical hernia and clubfeet. Treatment of the eyelids eversion was conservative, combining topical steroids, antibiotics and lubricants. Chemosis reduced progressively. We obtained a complete resolution on day 21. We referred the neonate to the pediatric surgery, and orthopedic department for umbilical hernia and clubfeet management., Clinical Discussion: Most infants with CUEE may show excellent anatomic and functional results with conservative treatment if managed timely and promptly., Conclusion: The innocuous appearance of CUEE must not prevent clinicians from investigating possible systemic associations and initiating appropriate treatment., Competing Interests: No conflict of interest., (© 2022 The Authors.)

Tuberculosis arthritis of the ankle accounts for 10% of all cases of osteoarticular tuberculosis (OT). Because of its rarity and insidious symptoms, diagnosing it may be challenging. Furthermore, its imaging findings mimic those of other diseases. The case of ankle tuberculosis arthritis misdiagnosed as talus necrosis is reported. The difficulties faced by clinicians when confronting such situations are also illustrated., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose of Review: Intravesical BCG therapy (ivBCG) is a treatment for bladder cancer that complements surgery and prevents tumor progression. Reactive arthritis (ReA) is a rare osteoarticular manifestation that can complicate this treatment. An updated systematic literature review has been investigated to identify clinical, biological, and therapeutic data of this pathology., Recent Findings: A systematic literature was performed on October 2020 to identify papers published from 2000 to 2020. Study eligibility criteria included case reports, case series, cohort studies, systematic reviews, meta-analysis, and letters to the editor, in English and French. Independent extraction of articles was performed by two investigators. Thirteen studies met the search criteria for the systematic review with a good quality assessment. The total number of patients was 107, with an average age of 61.5 [24-80]. The symptoms of ReA appeared after a mean number of 5.71 instillations and 13.9 days. Arthritis was the most common symptom (98.13%) followed by fever (80.76%) and conjunctivitis (64.42%). Human leukocyte antigen (HLAB27) was positive in 28.97% of patients. Therapeutic modalities included non-steroidal anti-inflammatory drugs (NSAIDs) (51.4%), corticosteroids (27.1%), conventional synthetic disease-modifying antirheumatic drugs (3.84%), antitubercular drugs (14.42%), and tocilizumab (0.93%). BCG therapy was discontinued in 29.9% of patients. Remission was achieved in 92.3% of patients and one patient progressed to spondyloarthritis. ReA is a rare complication of BCG therapy. Clinical signs are similar to those of typical ReA and treatment is primarily based on NSAIDs and corticosteroids.

To report the case of a surgical-induced necrotizing scleritis (SINS) following vitreoretinal surgery for rhegmatogenous retinal detachment, successfully managed by superficial muscle temporal fascia grafting. An 18-year-old teenager, with a history of a 23G vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment of the left eye, presented with intense left ocular pain, decreased visual acuity to counting fingers and eye redness. Split lamp examination showed: Conjunctival infiltration with silicone oil, circumferential sclera thinning with ectasia of the underling uvea. The fundus examination showed an attached retina. Necrotizing scleritis was the retained diagnosis. SINS was the final diagnosis. An immunosuppressive therapy was started. Superficial muscle temporal fascia grafting was performed to cover the necrotizing sclera. The patient did well postoperatively without sclera thinning or ectasia and the fascia grafting still intact without retraction after 6 months of follow-up. This is the first case in the literature that used the superficial temporal muscle fascia as a graft for sclera reinforcement in SINS. We propose new support to reinforce the deficient sclera. This graft must be associated with prompt immunosuppressive therapy at high doses., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Middle East African Journal of Ophthalmology.)

Aim: To evaluate the epidemiological and clinical characteristics of occupational ocular trauma in order to determine prognostic factors of these eye accidents., Methods: This is a cross-sectional study of 110 patients who were victims of occupational accidents that caused eye trauma. They were treated in Department A, Hédi Rais Ophthalmology Institute in Tunis, between March 2018 and March 2019. We collected information from the patients' files according to a standard form. The data collected were: patient demographics, circumstances of the accident, consultation time, clinical examination data and temporary disability. The data were entered and statistically analysed using SPSS 20.0 software. We used the "t-student" and the "chi-deux" as statistical tests. The significance level was set at 5%., Results: We collected 120 eyes from 110 patients. The average age was 37 years with a male predominance. Almost half of the patients (45.4%) were construction workers.  In 34% of the cases, a metal object was responsible for the trauma. Projection of superficial foreign bodies was noted in 44.3% of cases and contusion in 34% of cases. The average visual acuity of the traumatised eye was 8/10 and depended on the nature of the trauma.  Palpebral ecchymosis (30.9%) and conjunctival hyperhaemia (48.5%) were the most common bio microscopic signs found. Eight cases of corneal wounds were noted, three cases of corneo-scleral wounds associated in 2 cases with an intra-ocular foreign body as well as three cases of bursting of the globe were noted. The risk factors of poor prognosis found were: male sex (p=0.042), the mechanism of the trauma: projection of a foreign body (p=0.0052) and the following occupations: bricklayer, mechanic and construction worker (p<0.0001). The average temporary disability caused by eye trauma was 5 days with a standard deviation of 6 days., Conclusion: Our study described the severity of eye injuries related to work-related accidents. The most important prognostic factors will be the male gender, the mechanism of the trauma and the occupation. These traumas represent a major public health problem. Prevention is the only way to improve the final prognosis.

Aim: To determine the preoperative clinical and tomographic factors involved in the postoperative visual prognosis of macula-off rhegmatogenous retinal detachment., Methods: We conducted a prospective analytical study of 90 eyes of 90 patients who suffered from macula-off rhegmatogenous retinal detachment and were treated in department "A" of "Hedi Raies Institute of Ophthalmology", Tunis. All the patients were examined prior and after the operation, with a thorough interrogation and complete ophthalmological examination. Also, we continued assessing their status for 6 months. We looked for the clinical factors predictive of postoperative visual recovery. The data collected was stored using Excel software and analyzed using SPSS version 18 for Windows (IBM Corp., Armonk, NY). For all statistical tests, the significance level was set at p=0.05., Results: The mean preoperative visual acuity (VA) was 1.73 +/- 0.34 LogMAR. It was significantly correlated with management delay (p<0.001). Postoperative VA was 0.61 +/- 0.43 LogMAR. The various pre-operative clinical risk factors for poor final visual recovery (VA<5/10) were: preoperative VA ≥ 2 LogMAR, management delay > 15 days (p<0.01), proliferative vitreoretinopathy (PVR) stage C or greater (p=0.01), and number of detached retinal quadrants > 2 (p=0.05). Furthermore, we have found that the preoperative tomographic risk factors for poor visual recovery were: height of sub retinal fluid > 760µm (p < 0.001), disruption of the external limiting membrane and/or ellipsoid zone (p < 0.001), presence of cavitations in the external and/or internal nuclear layer (p = 0.002), and finally the absence of a thickening of the photoreceptor outer segments (p = 0.001)., Conclusion: Predictive preoperative clinical factors in macula off RRD are mainly preoperative visual acuity, the management delay, number of quadrants reached and PVR stage. Mastering these factors builds a better understanding of the functional recovery after macula-off retinal detachment and helps advise the patients who will consequently be more involved in the management of this serious disease. Spectral domain OCT allows detection of specific microscopic macular changes. These anomalies could be predictive of final postoperative visual outcome.

Introduction: Childhood ocular trauma is a preventable cause of visual impairment and blindness worldwide. The purpose of our study was to determine demographic, etiologic, and clinical characteristics, visual outcome, and factors affecting visual prognosis in children with open globe injuries (OGI) and to analyze the predictive value of ocular trauma scoring systems for OGI in children., Methods: We conducted a retrospective study enrolling 120 pediatric patients hospitalized for OGI from January 2010 to March 2017. Age, gender, date of trauma, time between trauma and presentation, place and circumstances of injury, etiology, visual acuity (VA), wound location and type of injury based on the Birmingham Eye Trauma Terminology, and the clinical signs were recorded. We recorded the number of surgical procedures performed, complications and visual outcomes., Results: The mean age was 7.38 years. In all, 62.5% of the patients were male, and 37.5% were female. The gender ratio was observed to decrease with increasing age. The mean time interval between injury and consultation was 22.80±42.68hours. Injuries usually occurred at home (80%) followed by playgrounds and sports venues (8.3%), the street (6.7%) and school (5%). All of the OGI's were accidental, and the main context was play (70%). The most common traumas were penetrating injury (60.8%) and metal (30%) objects. Penetrating trauma accounted for 68.3% of cases, followed by rupture (27.5%) and intraocular foreign body (IOFB) (7.5%). Initial VA was<1/10 in 59.2% of cases, and the point of entry was the cornea in 65.8% of cases. Final VA was<1/10 in 39.69% of all cases. FVA was significantly correlated with BCVA prior to the surgery, mechanism of the trauma, wound location and size, and other associated lesions. The Ocular Trauma Score (OTS) and the Pediatric Ocular Trauma Score (POTS) were significantly correlated with final VA., Conclusion: OGI's in children occurs most frequently in school-age boys. Prognosis is determined by presenting visual acuity, trauma score, and wound severity and location., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

A 45 years old patient consulted for a sudden decrease in visual acuity in the right eye. Ophthalmological examination gave visual acuity limited to luminous perceptions with a calm anterior segment, a transparent lens and at the fundus examination a dense, massive, two-level intra-retinal and retro hyaloidal pigeon nest hemorrhage with a fusiform whitish lesion on the path of the upper temporal artery. The suspected diagnosis was a complicated ruptured retinal macroaneurysm with massive retinal and retro hyaloidal hemorrhage. Fluorescein angiography confirmed the diagnosis. Our course of action was an emergency programmed evacuation vitrectomy with gas tamponade. The evolution was marked by a clear improvement in visual acuity. The rupture of retinal macroaneurysm is a frequent and serious accident. The complications of this rupture can threat the vision. Care is still being discussed. Randomized studies on large series are necessary to decide on the best therapy.

Introduction: Giant tear retinal detachments have long been recognized for their management difficulties and poor anatomical surgical prognosis., Method: Retrospective, descriptive study of 15 patients collected from IOHRT Department A. These patients were treated for rheumatogenic retinal detachment by giant tear. All patients underwent endocular vitreoretinal surgery. A visual acuity, FO and OCT check was performed at 7 days, 21 days, 45 days and 3 months, 6 months and 1 year postoperatively., Results: Our study included 15 eyes from 15 patients with rheumatogenic giant tear retinal detachments. The average follow-up is 9 months. The average age of the patients was 45 years. Six patients were severely short-sighted; 30% of patients had stage C vitreous proliferations at diagnosis. Immediate postoperative anatomical reapplication was achieved in 85% of patients. After 1 year, anatomical reapplication was achieved in 100% of patients. The average visual acuity was 2/10., Conclusion: Surgery for rheumatogenic retinal detachment caused by a giant tear is a procedure that is still considered difficult with uncertain results. The progress of endocular surgery and tamponade methods has made it possible to revolutionize the prognosis of these detachments.

Malignant glaucoma remains a challenging complications of ocular surgery. It has been reported to occur spontaneously or after any ophthalmic procedure, it is most commonly encountered after glaucoma surgery. The clinical diagnosis is made in the setting of a patent peripheral iridotomy and axial flattening of the anterior chamber. Intraocular pressure is usually elevated, but it may be normal in some cases. The exact etiology of this condition is not fully understood, several mechanisms have been proposed. This review discusses pathophysiology, differential diagnosis, imaging modalities, and current treatment strategies for this rare form of secondary glaucoma.

This study aims to identify the risk factors for post-traumatic endophthalmitis (PTE) due to intraocular foreign body (IFB) in patients with penetrating injuries of the globe and to assess treatment outcomes. We conducted a descriptive, retrospective study of 60 patients hospitalized for penetrating wound due to intraocular foreign body at the Hedi Rais Institute of Ophthalmology, Tunis, over a period of 10 years. Our study involved the patients with penetrating ocular trauma due to intraocular foreign body associated with post-traumatic endophthalmitis. We also determined the clinical risk factors for endophthalmitis in these patients. We collected data from the medical records of 60 patients with penetrating injury due to intraocular foreign body. Clinical symptoms of endophthalmitis were reported in ten of these patients (16.66%). All IFBs were located in the posterior segment. Mean LogMAR visual acuity (VA) at baseline was 2.26. Final Mean LogMAR VA was 2.18. We found a statically significant correlation between the occurrence of endophthalmitis and the following factors: rural origin p=0.021, delays in removing IFB p=0.01, posterior location IFB p=0.012, capsule rupture p=0.022, associated retinal detachment p<0.0001. The identification of risk factors for post-traumatic endophthalmitis allow for better treatment adaptation and preventive measures of this complication to improve prognosis and quality of life., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts., (© Olfa Fekih et al.)

The ankyloblepharon filiform adnatum (AFA) is a rare congenital palpebral abnormality characterized by a partial non disjunction of the gray lines of upper and lower eyelids. We report two cases of newborns presenting with ankyloblepharon and highlight its potentially amblyogenic impact and the possible ocular and systemic associations.

Aim: Given the increase in cases of fungal keratitis in recent years due to the inadvertent use of large -spectrum antibiotics and corticosteroids on the one hand and the emergence of contactology on the other hand, this study has was carried out in order to better understand the microbiological profile of fungal keratitis, particularly as a function of risk factors in a referral center in Tunisia., Methods: We report a retrospective study of 43 patients (45eyes) hospitalized for fungal corneal abscess between January 2007 and December 2017. All patients benefited from corneal sampling by scraping the cornea with direct examination and culture., Results: During the study period, 482 patients with corneal abscess were treated at the Ophthalmology Department of the Hédi Raies A Institute in Tunis. 45 eyes of 43 consecutive patients had keratomycosis (9.3%). The direct examination was positive in 71.1% of the cases and the culture in 73.3%. In 78.8% of the cases filaments were isolated: the fusarium being the most found species is in 39.4% of the patients particulary in cases of ocular trauma. Yeast species were more frequently found in surface pathology or local or general deficency., Conclusion:   It is important to guide the microbiological diagnosis of mycotic keratitis according to the clinical context, particularly in the case of negativity of the samples in order to establish a suitable treatment to improve the prognosis of this pathology, which represents one of the most difficult forms of infectious  keratitis to manage.

Aim: the interest of the OCT spectral Domain for the diagnosis of the acromatopsia., Case Report:   It's about 2 brothers consulting for low vision. The big brother, has a vision of 1/ 20 in two eyes. The anterior segment and the fundus examination were normals. The OCT SD shows a disappearance of the ellipsoid line in the macular region with an optic hole. The Global ERG has demonstrated flat plots in photopic component and normal in scotopic component. The ishihara test has showed an absence of the chromatic sense. The acromatopsia was the selected diagnosis.  The exam of the second brother showed a visual acuity limited 1/20 in the right eye and counting finger in the left eye, associated to photophobia and nystagmus. The OCT and global ERG gave the same results., Conclusion: The typical clinical picture with the ERG's data gave the diagnosis of the acromatopsia. An early diagnosis is necessary for a suitable life of the patient and genetic consulting. This paper demonstrated the importance of the OCT SD for the diagnosis when it's correclated to the clinic.

Introduction: The adenoviral keratoconjunctivitis infiltrates may be a source of significant visual impairment justifying the use of various therapeutic means., Aim: Evaluate the efficiency and safety of use of cyclosporine A 0,5% eye drop in the treatment of subepithelial infiltrates., Methods: It was a prospective study of 37 eyes of 22 patients with adenoviral keratoconjunctivitis with subepithelial infiltrates treated with cyclosporine A 0,5% eye drop. Cyclosporine A 0,5% was prepared from the injectable form of cyclosporine (Sandimmun®) and artificial tears. The cyclosporine A 0,5% was first administered at 4 drops per day for 15 days, then at a rate of 2 drops per day for a variable period ranging from 15 days to 6 months. The use of this molecule has been motivated by the presence of a persistent dazzlement, by visual acuity under 6/10 or an astigmatism superior to 1 diopter., Results: At the end of follow, dazzlement disappeared in all patients; the final average visual acuity was 8/10 and corneal astigmatism average was of 0.75 diopter. The slit lamp examination showed a marked decrease in the number and density of subepithelial infiltrates from the 15th day. A 29-year-old patient, however, presented some intercostal vesicles due to zonal recrudescence but with spontaneous and quick resolve in the same time of taking topical cyclosporine. No local complications were observed in our patients. The average follow-up was 13 months., Conclusion: Topical cyclosporine A is an effective and well-tolerated alternative to corticosteroids in the subepithelial infiltrates occurring as sequelae of adenoviral keratoconjunctivitis.

Introduction: The transconjunctival 23-gauge vitrectomy without sutures (VTCSS) combines the advantages of the 20 and 25-gauge system. It currently represents the gold standard for the surgical management of vitreoretinal pathologies, especially in diabetic patients., Aim: Evaluate the anatomical and functional results of the VTCSS 23 gauge in diabetic tractionnal retinal detachment (DRT)., Methods: This is a retrospective study of patients undergoing vitrectomy 23 gauges from February 2015 to February 2017. Each patient a complete ophthalmological examination with collection of  pre operative peroperative and postoperative data. The vitrectomy was performed by 3 ways through the 23-gauge cannula system Results :We collected 52 eyes presenting a DRT. The average age of patients was 50.62 years old. The average glycated hemoglobin (HBA1C) was 9.3%. The average time to treatment was 76.92 days. The results were as follows: For anatomical results: anatomical success rate was 92.30%. Functionally: A significant improvement in mean AV from 1/80 to 1.25 / 10 after surgery (p = 0.022), a statistically significant correlation between the final postoperative VA and the management delay (p <0.001); significant correlation between preoperative VA and final postoperative VA (p <0.001)., Conclusion: The VTCSS 23 gauge is an effective and safe surgery for DRT  surgery in diabetic patients with a gain in time and comfort for the patient.

Introduction: Choroidal neovascularization (CNV) is a rare complication after laser photocoagulation for central serous chorioretinopathy (CSCR).That's why , little is known about its management. Anti-VEGF therapy has emerged as the treatment of choice in patients with CNV. We report a case of a patient who developed iatrogenic CNV after having argon laser photocoagulation for a CSCR, treated with intravitreal injections of Bevacizumab., Aim: The goal of our paper is to show the efficacy and safety of the intravitreal injections of antiVEGF and discuss the alternative of argon laser photocoagulation to avoid complications., Case Presentation:   A 35-year-old pregnant woman diagnosed in August 2014 with an acute CSCR in the right eye. The patient was treated by a focal photocoagulation of the leakage point . In December 2015, she was complaining of metamorphopsia in the same eye .The BCVA was 10/10 in the right eye , and the funduscopic examination showed agrayish-white neovascular membrane, which corresponded to the area of the previous photocoagulation.The fluorescein angiography , OCT and the OCT angiography demonstrated the choroidal neovascular membrane .The patient received 3 intravitreal injections of Bevacizumab at monthly intervals in the right eye.The patient was followed-up at regular intervals and she became asymptomatic during three years., Conclusion: Choroidal neovascualrization may be an iatrogenic complication after argon photocoagulation in CSCR. Intravitreal injections of anti VEGF appear to be a promising treatment option for iatrogenic CNV due to photocoagulation.

Background: Postoperative endophthalmitis is a public health issue due to its bad prognosis; its treatment is both surgical and medical. Classically, surgical treatment was done if visual acuity is limited to light perception only., Aim: To evaluate therapeutic results Of postoperative endophtalmitieS and to Compare therapeutics almost used intravitreal injection of antibiotics versus early vitrectomy., Methods: It's a retrospective comparative study  includIng 120 cases of acute postoperative endophthalmitis hospitalized in a referral ophthalmology department between July 2007 and June 2013. A comparison was conducted between two groups of 24 and 94 patients; the first-line treatment was early vitrectomy for the first group and intravitreal antibiotic injection alone for the second group., Results: The overall incidence rate was 0.38 %, Streptococcus and Staphylococcus Epidermidis where the most common bacterial strain (16 patients each). The treatment outcome was very favorable for 11 patients with final visual acuity  higher or equal to 2/10, the outcome was intermediate for 43 patients and poor for 66 patients because of final visual acuity lower than or equal to 1/20, loss of media transparency or anatomical or functional loss of the eye. The prognostic factors statistically correlated to treatment outcome where intense initial inflammation (p<0.001), high bacterial virulence (p=0.002), bacteria culture positive to Streptococcus (p=0.024), a defectuous operative incision (p= 0.012), age over 80 (p=0.022) and posterior capsule rupture (p=0.013). Early vitrectomy group (group1) achieved a higher percentage of good outcome (60% vs 41.5%,  p=0.098 )., Conclusion: Functional result is better in the Vitrectomy group than in the antibiotic intravitreal injections group whereas not Statically signifiant.

Human adenoviruses (HAdVs) are common causes of conjunctivitis. This study describes the epidemiological features and characterizes by phylogenetic analysis HAdVs isolated from patients with conjunctivitis in Tunisia, North Africa. Data on out-patients presenting with conjunctivitis during 2 years (2012-2013) were analyzed. Conjunctival swabs obtained from 240 patients were assessed for the presence of HAdVs by PCR amplification on the fiber and hexon genes. Positive PCR products, together with those of nine viral isolates from previous years, were sequenced and analyzed phylogenetically. Conjunctivitis represented 11.5% of all reasons of consultations with a slight increase between mid-March and mid-June. Sixty-five percent of samples (n = 156) revealed positive by at least one PCR test. PCR amplification in the hexon gene was slightly more sensitive as compared to the fiber gene. Genotyping in the two genomic regions gave concordant results for almost all isolates. HAdV-D8 was the most predominant genotype (87.6%) and was detected continuously from 2000 to 2013. Minor co-circulating genotypes including HAdV-E4, HAdV-B3, HAdV-B55, and HAdV-D37 were identified; most of them were detected by amplification in the hexon gene. In conclusion, this work reports molecular data on adenoviral conjunctivitis from a region where such information is scarce and contributes to a better knowledge of the worldwide distribution of causative genotypes. It revealed a predominance and endemic circulation of HAdV-D8, a genotype that was mainly reported from epidemic keratoconjunctivitis. It shows that PCR amplification in two different genomic regions enhances the sensitivity of HAdV detection in clinical samples and the identification of minor genotypes. J. Med. Virol. 89:304-312, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Human adenoviruses (HAdV) are the main cause of viral conjunctivitis. In Tunisia and North Africa more generally, there is no regular nationwide surveillance program that monitors viruses causing conjunctivitis and keratoconjunctivitis. In this study, we report the results of HAdV screening in conjunctival samples collected for over 14 years in Tunisia. A total of 282 conjunctival samples received between 2000 and 2013 were investigated. Detection and identification of genotype were performed by PCR-sequencing at the hexon gene; 64.5% of samples (n=182) revealed positive by PCR detection without correlation noted between infection, age, sex, social class or clinical manifestations of viral conjunctivitis. HAdV-D8 was the largely predominant genotype in Tunisia, representing 81.3% of all isolates, and was detected continuously from 2000 to 2013. Minor co-circulating genotypes were also identified - HAdV-E4, HAdV-B3, B55 and HAdV-B7 - accounting for 10.7%, 4.9%, 1.9% and 0.9% of isolates, respectively. In conclusion, this work reports epidemiological data on adenoviral conjunctivitis from a region where such information is very scarce and contributes to a better knowledge of the worldwide distribution of causative genotypes. It also presents an approach for the identification of circulating HAdV in the country and demonstrates the importance of molecular tools for both detection and identification of genotypes, which allow rapid virological investigation, especially during epidemics., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: to assess clinical factors that may influence the prognosis of malignant melanoma of the uvea, Methods: We conducted a retrospective study from January 1990 to December 2013, involving 80 patients suffering from malignant melanoma of the uvea. We determined the location, the size, the tumor thickness, the clinicopathological aspect, the degree of pigmentation of the uveal melanoma, and associated signs Results: Factors significantly associated with poor prognosis were: a tumor location (p = 0.01), the infiltrative or fungus aspect (p = 0.001), a diameter equal to or larger than 10 mm (p = 0.003), the thickness greater than or equal to 5 mm (p = 10-3), achromatic or hyperpigmented melanomas (p = 0.02) and retinal detachment (p = 10-3)., Conclusion: Clinical prognostic factors are important to know because they determine the evolutionary profile and the metastatic potential of the uveal melanoma.

We report a case of a 52-year-old woman presented with atypical central serous chorioretinopathy (CSCR) that had been misdiagnosed as posterior uveitis and treated with systemic corticosteroids and immunosuppressive therapy, with subsequent severe chorioretinal damage. Diagnosis was straightened through multimodal imaging. Anatomical improvement was achieved after discontinuation of corticosteroids and intravitreal injection of bevacizumab. However, visual acuity remained severely impaired in one eye. Failure to differentiate atypical CSCR from inflammatory chorioretinal diseases may lead to severe and irreversible visual impairment. Multimodal imaging helps recognition of the atypical presentations of CSCR, avoiding misdiagnosis and inappropriate management.

Background: Thanks to the recent advances of the microsurgical techniques, the results of the congenital cataract surgery in children less than 5 years old have considerably improved. However, the age of implantation and the intraocular lens power calculation remain subjects of controversies., Aim: To evaluate the results of 2.2 mm micro-incision congenital cataract surgery in children less than five years old., Methods: Forty seven consecutive eyes of 26 children who had dense congenital cataract surgery were included in this retrospective study. All children had had the same surgical procedure: anterior approach through 2.2 mm corneal tunnel, posterior capsulorhexis associated to anterior vitrectomy and a primary foldable intraocular lens implantation. The final evaluation was at the same time anatomical and functional depending on the children age., Results: The median patient age of the children was of 23 months (6 to 54 months) and the sex ratio was 1.36 (15 boys / 11 girls). The cataract was bilateral in 77.7 % of the cases (21/27 children). The intraocular lens was implanted in the capsular bag in 93.6 % of the cases (44/47 eyes) and in the sulcus in 6.3 % of the cases (3/47 eyes). The postoperative complications were mild: inflammatory reaction limited to the anterior chamber in 17 % of the cases (8/47 eyes), opacification of the visual axis with a reproliferation of the epithelial cells behind the implant was observed in 4.25 % of the eyes (2/47 eyes). We noted no case of intraocular lens decentration or secondary glaucoma. The study of the refraction at last follow up showed a sphere average of 2.73 ± 1.21 diopters and mean astigmatism of 1.51 ± 0.82 diopters. The median best corrected distance visual acuity, evaluated in 12 children, was 5.2/10 ranging from 1/10 to 10/10. The amblyopia was also noted to 12/26 children (46.1 %). Among these children, 11/12 (91.6%) had a delay of surgery and 5/12 (41.6 %) had an unilateral cataract., Conclusion: Currently the anatomical prognosis of the congenital cataract surgery in children less than 5 years old is getting closer to that of the adult. However, the functional prognosis remains still unpredictable depending mainly on the deadline of surgery which remains very late in our series. Thanks to the improvement of the surgical techniques using microincision in cataract surgery and the new generation of foldable implants, the anatomical and functional prognosis of the congenital cataract have significantly improved.

Background: Diabetes is one of the principal cause of blindness in adults. The aim of the study is to evaluate the frequency of ocular complications and risk factors of diabetes. It's a multicentric prospective study on a representative sample of 285 diabetics., Methods: We performed a general and an ophthalmologic exam for all patients with retinal angiography and appropriate laboratory tests. Chi 2, Fisher, Mann and Whitney tests were used as statistical methods., Results: Diabetic retinopathy was observed in 45,2% of patients, cataract in 22%, glaucoma in 5%. Diabetic retinopathy frequency rises especially with duration of diabetes and bad glycaemic control. Blindness related to diabetic retinopathy was observed in 6,25% and visual deficiency in 12,5%. The authors compared their results with literature data. They emphasize on the great value of regular better glycaemic control and other associated metabolic disorders., Conclusion: We concluded that a regular ophthalmologic follow up is necessary for early diabetic retinopathy detection and treatment.

Introduction: Acanthamoeba keratitis is a rare but severe disease that can cause blindness. The objective of this study is to call attention to its severity and conditions of development and to emphasize the importance of early treatment., Case Report: We report a case of a 27-year-old woman. After wearing soft contact lenses for a month, she consulted for redness, pain and poor visual acuity in her left eye. The ophthalmological examination showed an epithelial corneal abscess measuring 2 mm in diameter in the left eye and very tiny epithelial corneal abscesses in the right eye. Microscopic examination and culture of samples from the contact lenses and the contact lens solution found Acanthamoeba spp. Rapid anti-amoeba treatment led to disappearance of the corneal abscesses and improvement of her vision., Conclusion: This case confirmed that the prognosis of Acanthamoeba keratitis depends on rapid diagnosis and early treatment.

Background: Occupational injury represents 7,7 at 69,9% of the total ocular traumatisms. They can be a major source of visuel loss and blindness. The aim is to study the epidemiology of work-related ocular injuries: objects frequencies,works most exposed., Methods: We performed a prospective study that interest 78 patients having a work-related ocular traumatism during a 4 months period. They were admitted at ocular emergeney All patients underwent an ophtalmologic examination completed with orbital radiography and echography. A medical and/or chirurgical appropriate treatment was institued., Results: Occupationnal injury frequency was 9% of the whole ocular traumatisms in the same period. The mean age was 31 years. 55% of cases were under 30 years. 91% were male. Most exposed works were industrial and mecanical sectors In 70,5% of cases work-related eye injuries were caused by projectile objects. Most common lesion was corneal superficial foreign body (58%). Open globe injury was noted in 8%. 95% of patients had no eye protection at the time of the accident. 13% were blind or unilateral partially sighted (according to the OMS classification)., Conclusion: The authors discussed the importance and different prevention strategies to prevent the risk of blindness and socio-economical cost of occupationnal accidents. There is a need for systematic periodic sensibilization to reduce these accidents and blindness.

Diabetes mellitus is usually accompagned with dyslipidemia, which can be correlated with diabetic retinopathy (DR). The aim of the study is to determine the relation between DR and hyperlipidemia. We studied prospectively 64 diabetic patients classified into 2 groups: the first associated diabetics having dyslipidemia (n=34) and the second without dyslipidemia (n=30). The mean follow up was 11 months. We observed a high frequency of retinal hard exudates in diabetics with dyslipidemia in comparison with the second group (32% versus 10%). The control of dyslipidemia is recommended in diabetic patients.

The main cause of oedematous branch retinal vein occlusion (BRVO) vision loss is macular oedema persistence. We studied 18 patients having oedematous branch retinal vein occlusion. An ophthalmologic exam completed with angiography and etiologic assessment were performed. Argon Laser macular grid photocoagulation was performed in 11 eyes where macular oedema had persisted for over 3 months with visual acuity under 5/10. In 45% of cases, occlusion interests superotemporal vein. Atherosclerosis risk factors are found in 88% of cases. The course was spontaneously favourable in 39% of cases. Improvement of visual acuity was obtained in 36% of cases treated with laser photocoagulation. Oedematous branch retinal vein occlusion outcome is variable; it can be favourable if veino-veinous anastomosis develops rapidly, or unfavourable with macular edema persistence and decreased visual acuity. In the later case, grid macular phototcoagulation should be performed leading to macular edema regression. So, macular edema secondary to branch retinal vein occlusion can disappear spontaneously and needs laser treatment only if it persists.

Terson syndrome or vitreal hemorrhage associated with subdural hemorrhage is a rare condition. The goal of our work through a retrospective series of 3 cases (4 eyes) is to study clinical characteristics as well as adequate moment of surgery. All our patients had unilateral or bilateral visual impairement secondary to cerebral lesion. Ophtalmologic exam showed an intravitreal hemorrhage. Two of our patients were operated by vitrectomy, the third case had a spontaneous resorption of intravitreal hemorrhage and no surgery was performed. Functional prognosis depends on neuro-ophtalmologic sequellas. Ophtalmic exam is essential in cerebral hemorrhage. For intravitreal hemorrhage spontaneous resorption is frequent and vitrectomy must be delayed.

Purpose: The aim of this study was to analyze the factors influencing the prognosis of retinoblastoma., Materials and Methods: In 50 children with retinoblastoma, 69 eyes were reviewed. All patients had a full ophthalmic examination, a B-scan ultrasound, a computerized tomography scan and a pediatric examination. We performed enucleation in 47 eyes (with a histopathological study), external beam irradiation in 16 eyes, curitherapy in 4 eyes, cryotherapy in 3 eyes, and adjuvant chemotherapy in 7 cases., Results: The global survival rate was 87.5%. The main aggravating factors were: the size of the tumor and the extraretinal involvement with extension within the chroid, the sclera, and the optic nerve., Conclusion: The prognosis of retinoblastoma mainly depends on the extraretinal invasion.

Orbital dermoid cyst represents 3 to 4% of all primary orbital tumours. The intraorbital location is relatively rare. We report the case of a 9 year-old male child with an orbital dermoid cyst, who presented with progressive right proptosis, which had developed 3 months earlier. Visual acuity, ocular motility and funduscopic examination were normal. Imaging aspects (ultrasonography and computed tomography) have revealed an extraconical orbital, hypodense, well limited tumor, without bone destruction and no enhancement located at the postero-external side of the orbit. The tumors was extirpated surgically via a superior approach. Histopathology confirmed the diagnosis of dermoid cyst.